Two days after blunt trauma to the right eye, a 4-year-old male patient presented in our ophthalmic clinic. The history of previous intraocular procedures and general diseases was negative.
A full ophthalmic examination with indirect biomicroscopy was performed. The visual acuity (VA) in the right eye was Hand Motion (20/4000; LogMAR 2.3) and was 20/25 (LogMAR 0.04) in the left eye. The intraocular pressure measured by palpation was within normal range. No abnormalities were found in the anterior segment of either eye, nor in the fundus examination of the left eye. The fundus examination of the right eye showed a full-thickness macular hole (FTMH) and upper temporal dialysis with total retinal detachment in all four quadrants. No choroidal rapture was detected.
SS-OCT (Swept source OCT), (DRI OCT Triton plus, Topcon, Japan) examination and eye ultrasonography were performed (Fig. 1, 2)
The patient was admitted to the ophthalmic department for surgical treatment.
The procedure was performed under combined intravenous-volatile anesthesia.
The eye was encircled with silicone band type 41 after placing mattress suture 6/0 Ethilon in four quadrants without tying. 23-gauge, 3-port traditional core and peripheral vitrectomy were then performed. Perifoveal posterior vitreous detachment (PVD) was observed. The ILM was stained for 1 minute with Membrane Blue dye (DORC, Rotterdam, the Netherlands). Perfluorocarbon (PFCL) (Perfluorodecalin, F-Decalin, Fluoron GmbH, Germany) was introduced and the inverted ILM flap technique was performed [12]. The ILM was grasped under PCFL during circumferential peeling and left attached to the edges of the macular hole and then inverted so that it was laying over the hole on the surface of the retina.
A small peripheral retinotomy was performed over the PCFL bubble to facilitate the subretinal fluid/air exchange. PVD was not forced to the periphery because of potential risk of iatrogenic breaks and was therefore finished at the temporal arcades. Extensive peripheral vitrectomy was avoided so as not to touch the lens and cause cataract.
After fluid/air exchange the eye was completely filled with PCFL, which was then exchanged for 5000 cs silicone oil. The 360° buckle was then sutured in order to close retinal dialysis, whilst carefully monitoring intraocular pressure. Sclerotomies were closed with Nylon 10/0 and conjunctiva with 7/0 Vicryl.
Successful macular hole closure was achieved and noted at the first control one week after surgery. The retina was reattached (Fig. 3). The silicon oil was removed after five months. Postoperatively, fovea architecture gradually improved and BCVA also showed improvement (Fig. 4a-e). Final VA improved to 20/80 (0.6 LogMAR). In the follow-up period (currently 12 months) no cataract formation has been observed.